Physician-Assisted Suicide and Therapeutic Ideation

Physician-assisted suicide proponents have been calling in favors to get in the media a lot recently, using sympathetic stories of disease to build goodwill towards their agenda. Rarely do they mention the failures and the bitter mechanics of the process, the gross lapses in oversight, or the threats to the disabled, elder adult, and depressed/suicide-minded communities.

Neither do they discuss the danger posed by assisted suicide to the healthcare community, those we all rely on for treatment and sound medical advice. But doctors, nurses, pharmacists, and coroners have expressed concern about assisted suicide as a threat to their professions and their conscience.

The very purpose of assisted suicide, after all, is to enlist healing professionals who have sworn to “first do no harm,” to put lethal means in the hands of vulnerable patients. Most versions of the Hippocratic Oath have physicians swear, “I will give no deadly medicine to any one if asked, nor suggest any such counsel”; in Roe v. Wade the U.S. Supreme Court called this Oath, with its 2500-year history, “the apex of the development of strict ethical concepts in medicine” and “the nucleus of all medical ethics.”

Prescribing fatal drugs with the express intent to kill flies in the face of the Hippocratic duty, and violates patients’ trust in physicians as healing, comforting professionals. In Blick v. Office of Div. of Crim. Justice, the Connecticut Superior Court listed numerous problems with assisted suicide, including the disintegration of the integrity of the medical profession and of the doctor-patient relationship. Americans echo these worries; many polls have found concerns about sloppy procedures on the part of doctors and that patients lose trust in a doctor who would be willing to participate in assisted suicide.

To conflate assisted suicide with medicine is to encourage patients to doctor-shop until they find an M.D. willing to write the scrip, treating doctors as vending machines rather than experienced professionals. Therefore, patients who should have received a referral for counseling and appropriate treatment have been documented to have simply visited doctor upon doctor in search of one who wouldn’t ask too many questions. Some patients, such as Jeannette Hall, have been saved due to the heroic efforts of a physician; others have not been so lucky.

Thus in Gonzales v. Oregon, Justice Scalia in dissent noted, “Virtually every relevant source of authoritative meaning confirms that the phrase ‘legitimate medical purpose’ does not include intentionally assisting suicide. ‘Medicine’ refers to ‘[t]he science and art dealing with the prevention, cure, or alleviation of disease.’” And in Washington v. Glucksberg, the U.S. Supreme Court cited the AMA determination that “[p]hysician-assisted suicide is fundamentally incompatible with the physician's role as healer.”

As Canadian hematologist Dr. Sheila Harding put it, assisted suicide “eviscerates what medicine is intended to be [and] is contrary to the very core of medicine.” A Canadian news article reported that Dr. Jennifer Tong warned, “‘coercing physicians against their conscience’ would damage patient-doctor relations and push some out of the profession.”

So the American Medical Association forbids doctors from “perform[ing] euthanasia or participat[ing] in assisted suicide.” Likewise, the American Nurses Association “prohibits nurses’ participation in assisted suicide and euthanasia because these acts are in direct violation of Code of Ethics for Nurses . . . , the ethical traditions and goals of the profession, and its covenant with society.”

Indeed, the very integrity of the medical profession depends on its ability to utilize the best practices, with the best information, to promote patient well-being. And the government has a role in the preservation of this integrity, as the U.S. Supreme Court found in Washington v. Glucksberg: the government undoubtedly “has an interest in protecting the integrity and ethics of the medical profession.”

But despite this clear incompatibility between assisted suicide and the healing profession, doctors, nurses, and pharmacists are facing forced participation in assisted suicide and/or euthanasia via mandatory provision or referral.

Most doctors do not want to participate in assisted suicide in any way, most recently confirmed by this year’s survey of Canadian physicians. Studies have shown a majority of nurses opposed to assisted suicide, as well. And most pharmacies, due to the thousands of drugs on the market and their limited shelf life, stock only a small percentage of the available drugs on the market at any given time; to do otherwise could run counter to demand and increase administrative burden, in addition to potentially violating the conscience. Yet Washington State has a history of intruding into pharmacy stockrooms and mandating that pharmacists order and stock certain drugs, when a patient could simply walk down the street to the next pharmacy and get that same drug. Pharmacists are right to be concerned about the government’s reaction to their conscientious objection to dispensing poison pills, just as doctors and nurses are about their prescription.

Conscientious objectors to assisted suicide should be able to practice their profession with confidence, knowing that the U.S. Constitution and federal statutes support their moral stand. Moreover, in Roe v. Wade, the U.S. Supreme Court quoted the AMA House of Delegates resolution affirming that “no physician or other professional personnel shall be compelled to perform any act which violates his good medical judgment [or] personally-held moral principles.”

Yet faced with unwilling agents of death, the Vermont Board of Medical Practice began to attempt to force doctors to counsel or refer their patients for assisted suicide. After Act 39, Vermont’s assisted suicide bill, passed with limited protections for conscientious doctors, Vermont’s medical licensing authorities, through the Vermont Department of Health, published FAQs on Act 39 that include:

Vermont medical professionals who hold opposing views and follow the dictates of their conscience rather than the dogma of the state are threatened with professional, civil, and criminal consequences. But rather than accept this perversion of their profession, in July the Vermont Alliance for Ethical Healthcare, Christian Medical & Dental Associations, member physicians, a member nurse, and a member pharmacist, through their attorneys with Alliance Defending Freedom, sued the Vermont Board of Medical Practice to assert their rights as conscientious objectors under the First Amendment Freedom of Speech and Free Exercise of Religion, Fourteenth Amendment Due Process, 42 U.S.C. § 1983 / Church Amendments and Affordable Care Act, and the State of Vermont Constitution and statutes. No government should order healthcare professionals to violate their conscience by encouraging patients to kill themselves, if they wish to continue in their healing profession.

Finally, coroners in California quickly grasped their state bill’s impact on their livelihood. First, as President Rocky Shaw of the California State Coroners Association wrote, coroners have concerns about “what [they] should do if a guy takes life-ending drugs [unbeknownst to the coroner] and then goes to sit in a park to die, and [they] find him there.” Presented with a body, how should a coroner proceed? Shaw questioned how the autopsy standards might change, both in terms of autopsy decisions and procedures. And one of the very points of assisted suicide is to have the death listed as something other than suicide; otherwise, a patient with suicidal ideation might go through with it without guidance from a doctor. Thus, coroners are being encouraged or even required to lie on death certificates by listing the patient's disease, not the drug, as the cause of death. Shaw questioned how to classify a death by assisted suicide. And if a death certificate lists a disease, not assisted suicide, as the cause of death, it could create a legal inability to prosecute criminal behavior and affect civil suits by dictating the legal fact that the death was caused by the underlying disease and not by an act of man.

As Dr. Kevin Fitzpatrick wrote, “When non-disabled people say they despair of their future, suicide prevention is the default service we must provide. Disabled people, by contrast, feel the seductive, easy arm of the few, supposedly trusted medical professionals, around their shoulder; someone who says ‘Well you’ve done enough. No-one could blame you.’”

Conscientious objectors to assisted suicide are bravely standing against the licensing of their professions to decide which lives are worth living, and which people are eligible for death. They are refusing to cooperate with government-endorsed suicide, and are reclaiming their professions for suicide prevention, for healing, and for life.

Works Cited

1. 410 U.S. 110, 131-32 (1973).

2. https://www.kofc.org/un/en/resources/communications/kofc-end-of-life-debate-ct-survey-032014.pdf

3. http://dailysignal.com/2015/05/18/assisted-suicide-how-one-woman-chose-to-die-then-survived/

4. https://dredf.org/public-policy/assisted-suicide/some-oregon-assisted-suicide-abuses-and-complications/

5. 546 U.S. 243, 285-86 (2006) (Scalia, J., dissenting).

6. 521 U.S. 702, 731 (1997) (quoting AMA, Code of Ethics § 2.211 (1994)).

7. http://www.cbc.ca/news/canada/nova-scotia/canadian-medical-association-still-polarized-by-doctor-assisted-deaths-1.3203143

8. http://www.theglobeandmail.com/news/national/less-than-a-third-of-doctors-willing-to-participate-in-assisted-dying-poll/article26100505/

9. American Medical Association, Decisions Near the End of Life H-140.966(4).

10. http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

11. 521 U.S. 702, 731 (1997).

12. https://www.cma.ca/Assets/assets-library/document/en/advocacy/maid-survey-summary-june-2016-english.pdf

13. http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Euthanasia-Assisted-Suicide-and-Aid-in-Dying.pdf

14. 410 U.S. 110, 144-45 n.38 (1973).

15. http://www.latimes.com/local/political/la-me-pc-california-coroners-have-issues-with-new-assisted-suicide-law-20151006-story.html

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